BACKGROUND: Myeloperoxidase (MPO) has been suggested to have a role in atherosclerosis through its strong oxidative capacity. We hypothesized that MPO level may predict clinical outcomes in patients with end-stage renal disease receiving long-term peritoneal dialysis (PD) therapy. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 236 long-term PD patients were recruited from a single regional dialysis unit in Hong Kong between April 1999 and February 2001. PREDICTOR: Level of plasma MPO, analyzed using a sandwich enzyme-linked immunosorbent assay. OUTCOME & MEASUREMENT: Mortality and fatal or nonfatal cardiovascular events at 3 years. RESULTS: The distribution of MPO levels was skewed with a median of 31.8 mug/L (25th-75th percentiles, 24.4-42.7). There were 69 deaths and 81 cardiovascular events. Adjusting for traditional and nontraditional risk factors and C-reactive protein, cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels, a doubling in plasma MPO level was associated independently with a 46% (95% CI, 1.02-2.08; P = 0.04) and 60% (95% CI, 1.17-2.18; P = 0.003) increase in risks of mortality and cardiovascular events, respectively. Log(2)MPO showed significant additional predictive value for mortality (P = 0.04) and cardiovascular events (P = 0.005) when included in Cox regression models consisting of clinical, demographic, dialysis, echocardiographic, and biochemical parameters, as well as C-reactive protein, cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels. LIMITATIONS: MPO was measured at a single time and did not reflect changes over time. CONCLUSIONS: These data suggest that plasma MPO level has significant independent and additional prognostic value beyond the standard clinical, biochemical, and echocardiographic parameters and is useful for outcome stratification in long-term PD patients. MPO may be an important mediator of increased cardiovascular risk in patients with end-stage renal disease and warrants further investigation.
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机译：背景：髓过氧化物酶（MPO）被认为通过其强大的氧化能力在动脉粥样硬化中起作用。我们假设MPO水平可以预测接受长期腹膜透析（PD）治疗的晚期肾病患者的临床结局。研究设计：前瞻性队列研究。地点和参与者：1999年4月至2001年2月，从香港的一个区域透析部门招募了236名长期PD患者。预测者：血浆MPO水平，使用夹心酶联免疫吸附法进行分析。结果与测量：3年时的死亡率以及致命或非致命的心血管事件。结果：MPO水平的分布偏斜，中位数为31.8马克杯/升（25-75％，24.4-42.7）。有69例死亡和81例心血管事件。调整传统和非传统危险因素以及C反应蛋白，心肌肌钙蛋白T和N端脑钠肽水平之前，血浆MPO水平加倍分别与46％（95％CI，1.02-2.08; P = 0.04）和60％（95％CI，1.17-2.18; P = 0.003）分别增加死亡率和心血管事件的风险。当将Log（2）MPO纳入包括临床，人口统计学，透析，超声心动图和生化参数以及C-Cox回归模型的死亡率（P = 0.04）和心血管事件（P = 0.005）时，它们具有显着的死亡率附加预测值反应蛋白，心肌肌钙蛋白T和N端脑钠素水平。局限性：MPO是一次测量的，不能反映随时间的变化。结论：这些数据表明血浆MPO水平具有超过标准临床，生化和超声心动图参数的重要独立和附加预后价值，可用于长期PD患者的结局分层。 MPO可能是终末期肾病患者心血管风险增加的重要介体，值得进一步研究。
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